Pethyabarn Wasuntaraporn, Chewae Sareeman, Dadeh Ar-Aishah
Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Emerg Med Int. 2020 Jun 29;2020:8261375. doi: 10.1155/2020/8261375. eCollection 2020.
We aimed to identify factors associated with treatment failure in patients with acute exacerbation of COPD (AECOPD) admitted to the emergency department observation unit (EDOU).
A retrospective cohort study was conducted between January 1, 2013, and October 31, 2019. The electronic medical records were reviewed of patients with AECOPD admitted to the EDOU. The patients were divided into treatment failure and treatment success groups. Treatment failure was defined as prolonged stay at the EDOU (>48 h) or COPD-related ED revisit (within 72 h) or readmission within 1 month. The two groups were compared and analyzed using univariable and multivariable analyses by logistic regression.
Of the 220 patients enrolled, 82 (37.3%) developed treatment failure. Factors associated with treatment failure included arrhythmias (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.04-13.9), diabetic mellitus (OR 2.32, 95% CI 1.09-4.95), long-term oxygen therapy (OR 2.89, 95% CI 1.08-7.72), short-acting beta-agonist use (OR 6.06, 95% CI 1.98-18.62), pneumonia findings on chest X-ray (OR 3.24, 95% CI 1.06-9.95), and ED length of stay less than 4 h (OR 2, 95% CI 1.08-3.73).
Arrhythmias, diabetic mellitus, long-term oxygen therapy, short-acting beta-agonist use, pneumonia findings on chest X-ray, and ED length of stay <4 h were the significant factors associated with treatment failure of AECOPD to which physicians at the ED should pay special attention before the admission of patients to the EDOU.
我们旨在确定急诊科观察病房（EDOU）收治的慢性阻塞性肺疾病急性加重（AECOPD）患者治疗失败的相关因素。
在2013年1月1日至2019年10月31日期间进行了一项回顾性队列研究。对收治到EDOU的AECOPD患者的电子病历进行了审查。患者被分为治疗失败组和治疗成功组。治疗失败定义为在EDOU停留时间延长（>48小时）或因COPD再次到急诊科就诊（72小时内）或在1个月内再次入院。通过逻辑回归采用单变量和多变量分析对两组进行比较和分析。
在纳入的220例患者中，82例（37.3%）出现治疗失败。与治疗失败相关的因素包括心律失常（比值比[OR]3.8，95%置信区间[CI]1.04 - 13.9）、糖尿病（OR 2.32，95%CI 1.09 - 4.95）、长期氧疗（OR 2.89，95%CI 1.08 - 7.72）、使用短效β受体激动剂（OR 6.06，95%CI 1.98 - 18.62）、胸部X线显示有肺炎（OR 3.24，95%CI 1.06 - 9.95）以及在急诊科停留时间少于4小时（OR 2，95%CI 1.08 - 3.73）。
心律失常、糖尿病、长期氧疗、使用短效β受体激动剂、胸部X线显示有肺炎以及在急诊科停留时间<4小时是与AECOPD治疗失败相关的重要因素，急诊科医生在将患者收治到EDOU之前应特别关注这些因素。
